Objectives

The objective of this study was to quantify the relative movement between the articular surfaces in the tibiotalar and subtalar joints during normal walking in asymptomatic individuals.

The timing of total hip replacement (THR) in patients with active tuberculosis (TB) of the hip is controversial, because of the potential risk of reactivation of infection. There is little information about the outcome of THR in these patients. We conducted a systematic review of published studies that evaluated the outcome of THR in patients with active TB of the hip. A review of multiple databases referenced articles published between 1950 and 2012. A total of six articles were identified, comprising 65 patients. TB was confirmed histologically in all patients. The mean follow-up was 53.2 months (24 to 108). Antituberculosis treatment continued post-operatively for between six and 15 months, after debridement and THR. One non-compliant patient had reactivation of infection. At the final follow-up the mean Harris hip score was 91.7 (56 to 98). We conclude that THR in patients with active TB of the hip is a safe procedure, providing symptomatic relief and functional improvement if undertaken in association with extensive debridement and appropriate antituberculosis treatment.

Cite this article: Bone Joint J 2013;95-B:578–82.

Introduction: Osteoporosis is a skeletal disorder characterised by decreased bone mineral density (BMD) and a subsequent increased risk of fragility fractures. This disease is commonly associated with postmenopausal females with an increasing incidence into later life, over 50% of females over 80 have osteoporosis. At the opposite spectrum of life, decreased BMD is traditionally associated with the female athletic triad, with hormonal imbalance leading to skeletal insufficiency. Considered a “silent disease” until a fracture occurs, as orthopaedic surgeons we must be able to identify those at risk of osteoporosis and refer promptly for dual energy x-ray absorptiometry (DEXA) scanning to prevent future fragility fractures in this specific patient cohort.

Methods: We carried out an epidemiological analysis of all female patients under the age of 30 referred for DEXA scanning in a university teaching hospital over a 3 year period. We analysed mode of referral, risk factors, T-score and subsequent fractures with an aim to highlight an underestimated level of osteopenia/osteoporosis in the younger patient.

Results: We identified 102 patients eligible for our study, with a mean age of 25.34 (Range- 17–29). As per the World Health Organisation (WHO) osteopenia was defined as osteopenia as a T-Score between −1 and −2.5, with osteoporosis below −2.5. The mean T score of these patients was −1.037 (range −3.2 to 2.4). Medical teams initiated the majority of referrals (77%), followed by General Practitioners (17%), Gynaecologists (4%), Paediatricians (1%) and Surgeons(1%). Risk factors included excess steroid use for medical conditions (41%), decreased body mass index (BMI) (27%), ceoliac disease (12%) and radiological evidence of osteopenia (7%). 34% of these patients had suffered a fall with 12% of patients suffering from a fragility fracture.

Conclusion: We identified a definite cohort of young female patients who had a mean T-score within the levels for osteopenia. Over one third had suffered a fall and 12% had suffered a fragility fracture despite a young age. With ever increasing patient numbers in both fracture and orthopaedic clinics and increased pressure on resources, it is imperative that we still take thorough histories to identify those young female patients that are at risk of osteoporosis. With appropriate follow up and investigations, they can be started on necessary treatment and prevent subsequent fragility fractures, the incidence of which appears to be underestimated.

Purpose: Recent advances in arthroscopic shoulder surgery has expanded the options available to surgeons repairing rotator cuff tears. There are now a variety of suture techniques that arthroscopists can use to fix tears but limited data on which might work best, particularly for double row techniques. The objective of this study was to compare the initial cyclic loading and load to failure properties of two arthroscopic double row fixation with that of the open double row technique.

Method: Thirty sheep shoulders were harvested and the infraspinatus tendons dissected free from all surrounding muscles and osseous attachments. Three double row stitch configurations (arthroscopic standard, arthroscopic mason-allen, open mason-allen) were performed and tested. The shoulders were then secured in a material testings machine and cyclically loaded between 5 and 100 N at 0.20 Hz for 10 cycles and then loaded to failure under displacement control at 1 mm/sec. Stiffness and ultimate load were measured and compared. The failure type, either through suture or anchor pull out, was also recorded.

Results: None of the specimens failed under cyclic loading. The ultimate load to failure was significantly higher for the open double row and the arthroscopic mason-allen compared to the standard double row technique. No significant differences in stiffness were found among the stitches. All failures occurred at the suture-tendon junction.

Conclusion: In this in vitro cadaver sheep study, the arthroscopic mason-allen and open mason-allen techniques had a significantly higher ultimate load to failure than the standard double row technique. Stitching methods that strengthen the tendon-suture interface can improve the strength of double row rotator cuff repairs.